The Etiology of Failure to Thrive: An Interactional Developmental Approach

Abstract

The goal of this paper is to present an interactional developmental framework for understanding the psychological issues underlying non-organic FTT in the first two years of life. The central theses are that growth failure is rooted in a transactional impasse between the infant and the caregiver, that the specifics of this impasse vary at different developmental stages, and that the etiology of FTT may be best understood in the context of the developmental issues negotiated between infant and caregiver during each stage. In this framework, growth failure is interpreted as the most concrete (and hence most noticeable) manifestation of impaired infant functioning in a variety of areas, particularly in socioemotional development. This formulation has important implications for treatment. For example, if therapeutic attention is focused exclusively on nutritional issues at the expense of broader interaction between infant and caregiver, the distortions in socioemotional development may persist in the form of ongoing psychological vulnerabilities and maladaptive patterns of adjustment.

Keywords

The authors wish to thank the following persons for their invaluable assistance in reviewing and commenting on the manuscript: Lester Eisenstadt, M.D.; Arthur Green, M.D.; Moses Grossman, M.D.; John Jemerin, M.D.; Elizabeth Mayer, Ph.D.; Jeree Pawl, Ph.D.; Stephen Seligman, D.M.H.; Calvin Settlage, M.D.; Robert Wallerstein, M.D.. Responsibility for the contents of this paper, however, rests solely with the authors.

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